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Oklahoma Department of Human Services
Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd. • Oklahoma City, OK 73105
(405) 521-3646 • Fax (405) 521-6684 • Internet: www.okdhs.org

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Last Updated:  11/19/2009
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OKDHS Home > Library > Forms > Forms and Applications for Services
Library: Forms
OKDHS Forms
To view these forms, please choose the associated icon under the View column. In order to view the forms correctly, site guests may need additional software. In some cases, forms are saved as .pdf or .doc files. To take full advantage of the OKDHS content, get the latest versions of Adobe Acrobat Reader or Microsoft Word Viewer from the Downloads and Plug-ins page.
Formas
333 forms found    Page 1  2  3  4  5  6  7   
View Form No.Legacy No.Results shown in ascending orderForm Name Category
Open Agency Certification Report (.pdf, 2 pp, 171 KB)
07LC047E
(OCC-047Agency Certification ReportChild Care Licensing  
Open Older Americans Act - Title III Acronyms, 12/15/2003 (.pdf, 2 pp, 27 KB)
A-4
02AX001EOlder Americans Act - Title III Acronyms, 12/15/2003Aging  
Appendices  
Open Long-Term Care (LTC) Services (.pdf, 2 pp, 82 KB)
A-7
02AX004ELong-Term Care (LTC) ServicesAging  
Appendices  
Open Eligibility Requirements for Long-Term Care Programs (.pdf, 2 pp, 86 KB)
A-8
02AX005EEligibility Requirements for Long-Term Care ProgramsAging  
Appendices  
Open Title III Reports Schedule (.pdf, 2 pp, 74 KB)
C-21
02AX006ETitle III Reports ScheduleAging  
Appendices  
Open Directory - Congregate Meals Program 09/10/09 (.pdf, 30 pp, 589 KB)
D-20
02AX007EDirectory - Congregate Meals Program 09/10/09Aging  
Appendices  
Open Job Descriptions for Older Americans Act Network Employees (.pdf, 61 pp, 340 KB)
M-14
02AX009EJob Descriptions for Older Americans Act Network EmployeesAging  
Appendices  
Open Eligibility Schedule/Rates for Adult Day Services (.pdf, 1 pp, 59 KB)
M-105
02AX010EEligibility Schedule/Rates for Adult Day ServicesAdult Day Services  
Appendices  
Open Child Support Services and Responsibilities (.pdf, 4 pp, 100 KB)
C-16
03AX016EChild Support Services and ResponsibilitiesAppendices  
Child Support  
Open Children and Family Services Division Rates Schedule 01/01/2009 (.pdf, 9 pp, 109 KB)
C-20_097_01012009
04AX003EChildren and Family Services Division Rates Schedule 01/01/2009Appendices  
Open Children and Family Services Division Rates Schedule 01/01/2009 (.pdf, 9 pp, 109 KB)
C-20
04AX003EChildren and Family Services Division Rates Schedule 01/01/2009Child Welfare  
Open AWOL Report (DCFS-EFC-2) (.doc, 1 pp, 698 KB)Open AWOL Report (DCFS-EFC-2) (.pdf, 1 pp, 131 KB)
04FE004E
04FE004EAWOL Report (DCFS-EFC-2)Child Welfare  
Emergency Foster Care  
Open Child Care Center Exclusion Criteria for Children Who Are III 09/15/2007 (.pdf, 2 pp, 70 KB)
L-6
07AX006EChild Care Center Exclusion Criteria for Children Who Are III 09/15/2007Appendices  
Child Care Licensing  
Open Maximum Income, Resource, and Payment Standards 10/01/2009 (.pdf, 8 pp, 115 KB)
C-1
08AX001EMaximum Income, Resource, and Payment Standards 10/01/2009Appendices  
Multiple Programs  
Open Maximum Food Benefit Allotments and Standards for Income and Deductions 10/01/2009 (.pdf, 37 pp, 860 KB)
C-3
08AX003EMaximum Food Benefit Allotments and Standards for Income and Deductions 10/01/2009Appendices  
Open Maximum Food Benefit Allotments and Standards for Income and Deductions 10/01/2009 (.pdf, 37 pp, 860 KB)
C-3_092_10012009
08AX003EMaximum Food Benefit Allotments and Standards for Income and Deductions 10/01/2009Food Stamps  
Open Maximum Income Limits and Benefit Allotments for FNS Declared Disasters 10/01/2009 (.pdf, 1 pp, 52 KB)
C-3-A
08AX004EMaximum Income Limits and Benefit Allotments for FNS Declared Disasters 10/01/2009Appendices  
Food Stamps  
Open Child Care Eligibility/Co-payment Chart 06/01/2008 (.pdf, 9 pp, 94 KB)
C-4
08AX005EChild Care Eligibility/Co-payment Chart 06/01/2008Appendices  
Child Care  
Open Standards for Expanded Medical Coverage Indicator (.doc, 1 pp, 659 KB)Open Standards for Expanded Medical Coverage Indicator (.pdf, 1 pp, 88 KB)
C-1-A
08AX010EStandards for Expanded Medical Coverage IndicatorAppendices  
Medical  
Open Facts About the Sales Tax Relief Act (.pdf, 1 pp, 51 KB)
A-3
08AX031EFacts About the Sales Tax Relief ActAppendices  
Multiple Programs  
Open Low Income Home Energy Assistance Program - Income and Resource Level by Household Size (.pdf, 1 pp, 43 KB)
C-7
08AX039ELow Income Home Energy Assistance Program - Income and Resource Level by Household SizeAppendices  
LIHEAP  
Open Sample Petitions and Court Orders (.pdf, 14 pp, 92 KB)
ST005E
13AX001ESample Petitions and Court OrdersAppendices  
Legal  
Open OKDHS Document Standards (.pdf, 8 pp, 101 KB)
ST002E
21AX002EOKDHS Document StandardsAppendices  
General Use  
Open OKDHS Document Division Codes (.pdf, 8 pp, 66 KB)
ST003E
21AX003EOKDHS Document Division CodesAppendices  
General Use  
Open OKDHS Document Category Codes (.pdf, 6 pp, 120 KB)
ST004E
21AX004EOKDHS Document Category CodesAppendices  
General Use  
Open Non-Discrimination Compliance (.doc, 1 pp, 658 KB)Open Non-Discrimination Compliance (.pdf, 1 pp, 132 KB)Open Non-Discrimination Compliance Instructions (.pdf, 1 pp, 13 KB)
14CR007E
AA-7Non-Discrimination ComplianceCivil Rights  
Open Authorization for Examination and Billing (.doc, 1 pp, 674 KB)Open Authorization for Examination and Billing (.pdf, 1 pp, 153 KB)Open Authorization for Examination and Billing Instructions (.pdf, 1 pp, 20 KB)
08MA016E
ABCDM-016Authorization for Examination and BillingMedical  
Open Request for Title XIX Nursing Assessment (.doc, 2 pp, 1132 KB)Open Request for Title XIX Nursing Assessment (.pdf, 2 pp, 150 KB)
02AG001E
ABCDM-083-ARequest for Title XIX Nursing AssessmentAging  
Open Notification Regarding Patient in a Nursing Facility (NF), Intermediate Care Facility for the Mentally Retarded (ICF/MR), or Hospice (.pdf, 2 pp, 36 KB)
08MA083E
ABCDM-083Notification Regarding Patient in a Nursing Facility (NF), Intermediate Care Facility for the Mentally Retarded (ICF/MR), or HospiceAging  
Open Request for Title XIX Nursing Assessment (.doc, 2 pp, 1132 KB)Open Request for Title XIX Nursing Assessment (.pdf, 2 pp, 151 KB)
02AG001E
ABCDM-083-ARequest for Title XIX Nursing AssessmentMedical  
Open Notification Regarding Patient in a Nursing Facility (NF), Intermediate Care Facility for the Mentally Retarded (ICF/MR), or Hospice (.pdf, 2 pp, 31 KB)
08MA083E
ABCDM-083Notification Regarding Patient in a Nursing Facility (NF), Intermediate Care Facility for the Mentally Retarded (ICF/MR), or HospiceMedical  
Open Management of Recipients Funds (.pdf, 2 pp, 81 KB)
08MA084E
ABCDM-096Management of Recipient's FundsAging  
Open Accounting - Recipients Personal Funds and Property (.pdf, 1 pp, 11 KB)Open Accounting - Recipients Personal Funds and Property Instructions (.pdf, 1 pp, 18 KB)
08MA085E
ABCDM-096-AAccounting - Recipient's Personal Funds and PropertyMedical  
Open Management of Recipients Funds (.pdf, 2 pp, 34 KB)
08MA084E
ABCDM-096Management of Recipient's FundsMedical  
Open Ledger Sheet for Recipients Account (.pdf, 1 pp, 13 KB)Open Ledger Sheet for Recipients Account Instructions (.pdf, 1 pp, 17 KB)
08MA021E
ABCDM-099Ledger Sheet for Recipient's Account Medical  
Multiple Programs  
Open Report of Physicians Examination (.doc, 2 pp, 745 KB)Open Report of Physicians Examination Instructions (.pdf, 1 pp, 18 KB)
08MA080E
ABCDM-80Report of Physician's Examination Medical  
Open Accounting - Recipients Personal Funds and Property (.doc, 1 pp, 667 KB)Open Accounting - Recipients Personal Funds and Property Instructions (.pdf, 1 pp, 23 KB)
08MA085E
ABCDM-96-AAccounting - Recipient's Personal Funds and Property Aging  
Medical  
Open Ledger Sheet for Recipients Account (.doc, 1 pp, 737 KB)Open Ledger Sheet for Recipients Account Instructions (.pdf, 1 pp, 18 KB)
08MA021E
ABCDM-99Ledger Sheet for Recipient's Account Medical  
Open Confidential Intake Form (.doc, 6 pp, 818 KB)Open Confidential Intake Form (.pdf, 6 pp, 376 KB)
09AI002E
ACIS-2Confidential Intake FormApplications  
Field Operations  
Open Request for Reasonable Accommodation - Employee or Applicant for Employment (.doc, 1 pp, 668 KB)
14CR003E
ADA-1Request for Reasonable Accommodation - Employee or Applicant for EmploymentCivil Rights  
Open Request for Reasonable Accommodation - Client or Applicant for Services (.doc, 1 pp, 668 KB)
14CR004E
ADA-2Request for Reasonable Accommodation - Client or Applicant for ServicesCivil Rights  
Open Adult Day Service Invoice (.doc, 1 pp, 82 KB)Open Adult Day Service Invoice Instructions (.pdf, 2 pp, 16 KB)
02AS001E
ADM-012-ADS-SIAdult Day Service Invoice Adult Day Services  
Aging  
Open Employment Verification (.doc, 4 pp, 1.1 MB)Open Employment Verification (.pdf, 4 pp, 226KB)Open Employment Verification Instructions (.pdf, 1 pp, 13 KB)
08AD094E
ADM-094Employment VerificationMultiple Programs  
Open Risk Management Survey (.doc, 3 pp, 755 KB)Open Risk Management Survey Instructions (.pdf, 1 pp, 43 KB)
23RS109E
ADM-109Risk Management Survey Risk Management  
Open Leave Option Election - Work-related Accident/Illnesss (.doc, 1 pp, 584 KB)Open Leave Option Election - Work-related Accident/Illnesss (.pdf, 1 pp, 160 KB)Open Leave Option Election - Work-related Accident/Illnesss Instructions (.pdf, 1 pp, 11 KB)
23RS113E
ADM-113Leave Option Election - Work-related Accident/IllnesssRisk Management  
Open Certification for Special Needs Child Care Rate (.doc, 5 pp, 626 KB)Open Certification for Special Needs Child Care Rate Instructions (.pdf, 2 pp, 23 KB)
08AD006E
ADM-123Certification for Special Needs Child Care Rate Child Care  
Open Claim Form (.doc, 2 pp, 722 MB)Open Claim Form (.pdf, 2 pp, 199 KB)Open Claim Form Instructions (.pdf, 2 pp, 48 KB)
10AD012E
ADM-12Claim FormContracts and Purchasing  
Open Child Care Claim (.doc, 2 pp, 982 KB)Open Child Care Claim (.pdf, 2 pp, 182 KB)
10AD121E
ADM-12-SChild Care ClaimChild Care  
Finance  
Open Request for Background Check (.doc, 1 pp, 588 KB)
04AD003E
ADM-130Request for Background CheckChild Welfare  
Multiple Programs  
Open Request for Approval of Leave (.doc, 2 pp, 693 KB)Open Request for Approval of Leave (.pdf, 2 pp, 193 KB)Open Request for Approval of Leave Instructions (.pdf, 3 pp, 25 KB)
10AD001E
ADM-1Request for Approval of LeaveFinance  
Personnel  
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Street address: Oklahoma Department of Human Services
Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd., Oklahoma City, OK 73105
Mailing address: P.O. Box 25352, Oklahoma City, OK 73125
(405) 521-3646